CHICAGO—Adolescents with major depressive disorder showed improvement after treatment that combined fluoxetine (an antidepressant medication) and cognitive behavioral therapy (CBT), according to the results of the Treatment for Adolescents with Depression Study (TADS) published in the August 18 issue of JAMA, the Journal of the American Medical Association.

According to background information in the article, major depressive disorder (MDD) is common in adolescence. "...depression in adolescence is a major risk factor for MDD, suicide, and long-term psycho-social impairment in adulthood. Thus, improvements in the treatment of MDD among adolescents should positively affect public health."

John S. March, M.D., M.P.H., from Duke University Medical Center, Durham, N.C., and colleagues from the TADS team, evaluated the effectiveness of four treatments among adolescents with MDD. This study included 439 patients with a primary diagnosis of MDD who ranged in age from 12 to 17 years. They enrolled in the study between spring 2000 and summer 2003 at 13 academic and community clinics across the United States. The participants were randomly assigned to twelve weeks of fluoxetine alone, CBT alone, CBT with fluoxetine, or placebo (sugar pill). "In TADS, CBT is a skills-oriented treatment based on the assumption that depression is caused by or maintained by depressive thought patterns and a lack of active, positively reinforcing behavioral patterns; treatment included 15 sessions, which lasted between 50 and 60 minutes, over the first 12 weeks," the authors describe.

"Compared with fluoxetine alone and CBT alone, treatment [combining] fluoxetine with CBT was superior," the authors report. "Fluoxetine alone is a superior treatment to CBT alone. Rates of response for fluoxetine with CBT were 71 percent; fluoxetine alone, 60.6 percent; CBT alone, 43.2 percent; and placebo, 34.8 percent. ...Clinically significant suicidal thinking, which was present in 29 percent of the sample at baseline, improved significantly in all 4 treatment groups. Fluoxetine with CBT showed the greatest reduction. Seven (1.6 percent) of 439 patients attempted suicide; there were no completed suicides." The researchers also found treatment with fluoxetine alone elevated the risk for psychiatric adverse events. "While fluoxetine did not appear to increase suicidal ideation [thoughts], harm-related adverse events may occur more frequently in fluoxetine-treated patients and CBT may protect against these events," the researchers add.

CHICAGO—The addition of six months of androgen suppression therapy (AST) to radiation therapy improves survival of patients with clinically localized prostate cancer, according to a study in the August 18 issue of JAMA, the Journal of the American Medical Association.

"Combining three years of AST with 70 Gy RT (dose of radiation therapy) has been shown to improve survival rates for patients with locally advanced prostate cancer," the authors provide as background information. "However, the toxicity of long-term AST can be significant, particularly in elderly patients." AST is a treatment that inhibits the release of androgen, the male sex hormone.

Anthony V. D'Amico, M.D., Ph.D., from Brigham and Women's Hospital, Boston, and colleagues, assessed the survival benefit of 3-dimensional conformal radiation therapy (3D-CRT) alone or in combination with 6 months of AST in patients with clinically localized prostate cancer. The 206 patients were randomized to receive 70 Gy 3D-CRT alone (n=104) or in combination with 6 months of AST (n = 102) from December 1, 1995 to April 15, 2001. The patients included those with a prostate specific antigen (PSA) of at least 10 ng/mL, a Gleason score (grading system for prostate cancer) of at least 7, or radiographic evidence of disease outside the prostate. Follow-up visits were performed at the end of radiation treatment every 3 months for 2 years, every 6 months for an additional 3 years, and then annually until death or January 15, 2004, the end of the study.

"After a median (midpoint) follow-up of 4.52 years, patients randomized to receive 3D-CRT plus AST had significantly higher survival, lower prostate cancer-specific mortality [death], and higher survival free of salvage AST [salvage treatment is used when cancer recurs after initial treatment]," the authors found. Standardized estimates of 5-year survival rates were 88 percent in the 3D-CRT plus AST group vs. 78 percent in the 3D-CRT group. Rates of survival free of salvage AST at 5 years were 82 percent in the 3D-CRT plus AST group vs. 57 percent in the 3D-CRT group." The researchers note there were 6 deaths due to prostate cancer and 17 from other causes for patients receiving 3D-CRT. For patients receiving 3D-CRT plus AST, no deaths occurred due to prostate cancer and 12 were from other causes.

CHICAGO—Vitamin E does not appear to have a beneficial effect on lower respiratory tract infections in elderly nursing home residents, but it may help them ward off upper respiratory tract infections, according to a study in the August 18 issue of JAMA, the Journal of the American Medical Association.

"Infections, particularly respiratory tract infections, are common in elderly individuals, resulting in decreased daily activity, prolonged recovery times, increased health care service use, and more frequent complications, including death," the authors provide in background information. "In the United States, an estimated 43 percent of elderly persons will be admitted to a nursing home, with more than 85 percent of them admitted to long-term (more than one year) care facilities. Infections occur more frequently in nursing home residents than among independent-living elderly..."

Simin Nikbin Meydani, D.V.M., Ph.D., from Tufts University, Boston, and colleagues enrolled 617 persons at least 65 years old in 33 long-term care facilities from April 1998 to August 2001 to participate in a clinical trial to determine the effect of one-year of vitamin E supplementation on respiratory tract infections in elderly nursing home residents. The study participants were randomized to two groups. All participants received a multivitamin capsule with 50 percent of the recommended daily allowance (RDA) for essential micronutrients. The vitamin E group (n = 311) received a daily capsule containing 200 international units (IU) of vitamin E and the control group (n = 306) received a placebo capsule. A total of 451 participants (73 percent) completed the study.

"Vitamin E had no significant effect on incidence or number of days with infection for all, upper, or lower respiratory infections. However, fewer participants receiving vitamin E acquired one or more respiratory tract infections (60 percent vs. 68 percent for all participants; and 65 percent vs. 74 percent for completing participants), or upper respiratory tract infections (44 percent vs. 52 percent for all participants; and 50 percent vs. 62 percent for completing participants)," the authors found. In analysis the authors had not planned before conducting the study, the researchers report that "participants in the vitamin E group who completed the study had significantly fewer common colds and a 20 percent lower risk of acquiring a cold than those in the placebo group."

FLUOXETINE PLUS COGNITIVE BEHAVIORAL THERAPY SUPERIOR FOR TREATING TEEN DEPRESSION COMPARED TO MEDICATION OR THERAPY ALONE